(In part one of this series, A.C. Dhariwal, the NVBDCP’s director, accepts that the numbers are flawed but insists the program’s efforts are unharmed because the system accurately captures trends in the spread of the disease. “Malaria numbers are going down,” he says. “Our biggest challenge is continuing our efforts and consolidating the gains.” Part two discusses the importance of Long-lasting insecticidal nets which will help curb malaria yet the fact that 99 percent of Indians do not use it persists. While the Government from 2012-2014 did not purchase a single LLIN to distribute to the 250 million people most at risk, they have purchased 12.4 million nets 2014 onwards and plan to buy 5 million more this year.)

When it comes to malaria control, Madan Pradhan is often cited as a superstar. Since he took charge of Odisha’s program nearly a decade ago, the rate of malaria deaths dropped by 75 percent in the state, which bears a fifth of the country’s malaria burden. Meanwhile, he pushed to get more accurate data.

In the face of understaffed clinics and mismanaged funds, he says his first move was to make the neglected program a high priority in the state secretariat. He says he persuaded the Health Ministry to increase funding for the program, from roughly $61,000 to $3 million. And he encouraged district officers and health workers to be more transparent about the deaths in their area.

“It needs a lot of advocacy and passion,” he says. “I can’t boast that all cases are captured, but the surveillance system is improving.”

To combat the hurdles in prevention and treatment of the disease, Pradhan lobbied for mosquito nets at the state and national level, he says, and managed to obtain and distribute 1.1 million treated nets in 2009. He credits this intervention, along with the new rapid diagnostic kits that were distributed to community health workers in each village to test for malaria, for the improvement. Malaria deaths in Odisha dropped from 465 in 2002 to 100 in 2011.

But Odisha is not immune to the precarious relationship between the Indian government and its international funding agencies. After the World Bank project ended in 2013, nets became scarce, and Pradhan says he has had trouble accessing the central government funds allotted to malaria.

To make matters more difficult, malaria is hardly a political priority. The 5.05 billion rupees, or $76 million, the central government allocated to the NVBDCP last year, for instance, makes up just 1.7 percent of the country’s already feeble health budget. And the government’s continued neglect of the disease means there is a perennial threat of funding cuts that could trigger a global resurgence in the disease, according to a 2012 Malaria Journal study.

Dhariwal, the national malaria program director, insists there is enough domestic funding for the malaria program, pointing out that federal contributions are matched by state governments. In fact, he says, the program is stronger than before, with new innovations and consistent midterm evaluations.

“We are not worried about the budget,” he says. “Whatever logistic support was there [from the World Bank], we are continuing from our own money with domestic support. The Indian program is resilient.”

But on the ground, the absence of basic malaria prevention resources suggests a sizable shortfall.

Paraja Dadra, a malaria-prone village of tin-roofed huts amid fields of rice in Odisha, has no community health worker. Limdas Naik, 23, a poor laborer, says his 5-year-old son, Amit, ran a high temperature for two weeks last year before a health worker showed up to check for malaria. By then, Naik’s other son also came down with a fever.

Both boys tested positive for P. falciparum, the deadliest strain of malaria in India and one of the most common, and didn’t respond to oral medication, which is effective only when administered within 24 hours of the appearance of symptoms. The Naiks paid 400 rupees, a significant chunk of their monthly income, for their children to be rushed to the government hospital in Koraput, the district headquarters. His wife slept on the streets outside the hospital for 15 days while her already malnourished sons received treatment and an IV drip.

“I feared for my boys,” says Naik as he cradles scrawny Amit, who was still recovering at the time of the interview.

If the malaria program is properly carried out, the majority of such patients should be diagnosed and treated in their villages or at the local primary health clinic. But if intervention is delayed, complications arise and patients require hospitalization.

The Koraput district hospital is meant to be the last resort for the most complicated cases, but like most public hospitals in India, it is often the first. The facility is overcrowded, filled with patients sleeping on the floors of grimy wards that have run out of beds. A lean team of nurses and doctors struggles to treat malaria cases, which pour in daily — many of them complex and serious. In July 2014, for example, hospital records showed that doctors had 73 cases of cerebral malaria, the most severe stage of the disease, which is often a sign of neglect or late diagnosis, according to The American Journal of Tropical Medicine and Hygiene.

Like Pradhan, Dr. Bijaya Kumar Mohapatra, a surgeon and the assistant district medical officer of the hospital, says there has been a decline in malaria cases and deaths in Odisha. But he also says that the hospital, which has 10 doctors and a total staff of 46, is severely short on resources.

To make matters even more complicated, a huge number of poor people opt for health care in the largely unregulated private sector, in which doctors often have not received formal medical training. These doctors have a tendency, Mohapatra adds, to overprescribe antibiotics — which can create drug resistance in the entire community — and pander to patients’ preference for injectable treatment, even when unnecessary. Private doctors are also unlikely to report malaria deaths, he says.

“We are so overstretched,” he says. “The government has created a number of posts … but the budget was not provided or clear … We recently got a dialysis machine [which is needed for treatment, since malaria can affect kidney function], but it is still sitting there in its packaging. We don’t have anybody trained to use it.”

Part 4: An uncertain future

These health system failures and the dearth of reliable data have created a vicious cycle, says Jain, the public health advocate. The lack of records limits efforts to find and stop malaria, and the high rates of illness threaten an already overburdened system, making it even harder to report the numbers and ask for adequate resources to prevent and treat the disease.

Dhariwal insists that the national malaria program is swiftly rectifying this problem. Last year the Indian government commissioned a study to gather accurate data through the National Institute of Malaria Research, which Dhariwal says will be completed in the next two years. And the Health Ministry now has its own procurement agency, the Central Medical Supply Scheme.

If the program can be turned around, it means both humane practices and economic gains for India. One study says every rupee spent on malaria results in almost 20 rupees added to the economy.

Until then, malaria remains a disease of the poor, with deaths tucked away in the villages and hills, far from India’s rapidly expanding cities.

“It’s a national disaster,” says malaria researcher Sharma. “The poor man has no voice.”

That continues to be the experience of families living at the top of the hill in Chintalaveedhi or among the paddies in Paraja Dadra. Balaraju Raasa sits on the dusty porch of the home they can’t afford to finish building. He says his family is still trying to recover.

“She was a good girl, a hard worker,” he says of his daughter-in-law, as her children play behind him. “But we lost all of our savings, and we lost our daughter.”

The reporting of this story was supported by the Fund for Investigative Journalism. This article was first published on Al Jazeera.